Real-world study (RWS), based on multi-source data from real medical environments, is gradually becoming an important supplement to traditional randomized controlled trials, and its application in the field of transfusion medicine is becoming increasingly widespread. This article systematically reviews the definition and methodological system of RWS, examines its application cases in clinical blood transfusion research, and discusses the advantages, limitations, and future research directions of RWS, aiming to provide a reference for evidence-based research in blood transfusion medicine.

Real-world study (RWS), based on multi-source data from real medical environments, is gradually becoming an important supplement to traditional randomized controlled trials, and its application in the field of transfusion medicine is becoming increasingly widespread. This article systematically reviews the definition and methodological system of RWS, examines its application cases in clinical blood transfusion research, and discusses the advantages, limitations, and future research directions of RWS, aiming to provide a reference for evidence-based research in blood transfusion medicine.

Objective To observe the value of transesophageal echocardiography(TEE)for guiding left atrial appendage closure(LAAC)with LAmbre occluder.Methods Data of 40 non-valvular atrial fibrillation(NVAF)patients who underwent LA AC with LAmbre occluder were retrospectively analyzed.CT angiography(CTA)before treatment,TEE and digital subtraction angiography(DSA)findings during LAAC were comparatively observed,and the correlations of the anchor area diameter and left atrial appendage opening diameter measured with the above three as well as occluder size were analyzed,and TEE and DSA for evaluating peri-device leak(PDL)were compared.Results LAAC were successfully performed with LAmbre occlude in all 40 cases.The diameter of the fixed umbrella was positively correlated with anchor area diameter measured with CTA,TEE and DSA(r=0.79,0.82,0.91,all P＜0.01),of occlusion umbrella was positively correlated with left atrial appendage opening diameter measured with CTA,TEE and DSA(r=0.56,0.89,0.86,all P＜0.01).Immediately after the release of occluder in LAAC,PDL occurred in 16 cases and were detected with both TEE and DSA,while in the rest 24 cases no PDL was found with neither TEE nor DSA.Conclusion TEE had comparable value to DSA for guiding LAAC using LAmbre occluder.

Objective To systematically evaluate the psychological feelings and real experience of ICU nurses'moral dilemma,and the aim is to provide references for the formulation of targeted psychological intervention programs.Methods Pubmed,CINAHL,Embase,Web of Science,Cochrane Library,PsycNET,CNKI,Wanfang database,VIP database,and China Biomedical Literature Database were searched by computer to retrieve qualitative studies on psychological perceptions and real experiences of moral dilemmas of ICU nurses,and the search time was from the establishment of databases to March 2023.The quality of literature was evaluated using the 2016 version of the Australian JBI Centre for Evidence-Based Health Care Quality Evaluation Criteria for qualitative studies,and the results were integrated and analyzed by the Meta integration method.Results A total of 10 pieces of literature were included,including 3 phenomenological studies and 7 descriptive studies.The results of 27 studies were summarized into 8 new categories,and 3 integrated results were obtained:①The internal and external causes of moral dilemmas,including conflicting concepts of life and death,differences of the idea of the superior death,conflict of clinical decision-making,and insufficient organizational support;②The progressive effects of moral dilemmas,including aggravating negative emotional burden and breeding professional identity bias;③ Coping strategies for moral dilemmas,including active self-debugging and seeking support from colleagues.Conclusion It is urgent to popularize the scientific concept of life and death of patients and families,deepen the concept of superior death of ICU nurses,and alleviate the conflict of nursing and patient decision-making.It is important to pay attention to the negative emotional state of ICU nurses,improve their professional identity,improve the self-adjustment ways of ICU nurses,and to provide multi-organization support for ICU nurses.

Objective:To understand the characteristics and diagnosis and treatment of brucellosis with joint pain as the first clinical manifestation, and summarize the clinical classification of brucellosis complicated with joint pain, so as to provide reference for clinical diagnosis and treatment.Methods:Cases of brucellosis with first symptom of joint pain diagnosed in the 940th Hospital of PLA Joint Logistic Support Force from January 2015 to January 2020 were selected. The main clinical features, laboratory examination, diagnosis and treatment were analyzed.Results:A total of 82 patients with joint pain of the first symptom were selected, including 61 males and 21 females. Joint pain was the main complaint of the patients, 63.4% (52/82) of the patients visited spine surgery department, 17.1% (14/82) visited minimally invasive orthopedics department, 12.2% (10/82) visited rheumatic immunology department, and 7.3% (6/82) visited traditional Chinese medicine department. Brucellosis patients with cervical lesions accounted for 22.0% (18/82), combined with lumbar lesions accounted for 51.2% (42/82). The patients with elevated C-reactive protein accounted for 68.3% (56/82), abnormal liver function accounted for 52.4% (43/82), anti "O" positive accounted for 3.7% (3/82), abnormal autoantibodies accounted for 6.1% (5/82), and human leukocyte antigen-B27 (HLA-B27) positive accounted for 12.2% (10/82). Four patients with HLA-B27 positive had sacroiliac arthritis. All patients were cured after standard and full course therapy.Conclusion:Joint pain may be the first symptom of brucellosis, and the lumbar spine and cervical spine are the most vulnerable parts.

Clinical microbiology examination technology experiment is an important part of clinical microbiology examination technology teaching. In the experimental teaching of clinical microbiology examination technology, the virtual simulation technology was combined with traditional teaching to give full play to the advantages of the virtual experimental platform. As to experimental projects that couldn't be carried out in traditional teaching and some important experimental projects, students could learn on the virtual experimental platform, and after learning, they would participate in the corresponding assessment. The perfect combination of the two can solve the problem of high experimental cost and limited experimental content in the current experimental class, make up for the shortcomings of traditional teaching, realize the sharing of teaching resources. Besides, it can strengthen the students' experimental operation skills and enhance the interest of learning for cultivation of application-oriented medical talents.

Objective: To reveal intuitively the micro and macro structure of school health research in China, in order to lay a solid foundation for further study. Methods: Statistical analyses the current status of 864 high-level journal papers in the field of school health in China by EXCEL and SATI software, author cooperation and organization cooperation, research hotspots and frontier trend knowledge maps were drawn by Citespace. Results: The research in the field of school health in China shows a wavy growth trend, the contribution of Chinese Journal of School Health is the biggest(757). Ma Jun, Tao Fangbiao, Wang Zhiyong, Liu Wei, Duan Jiali, Xu Yong are high-yield authors, Peking University, Anhui Medical University, Dalian City and Beijing Center for Disease Control and Prevention are high-yield institutions. Author cooperation and institutional cooperation are relatively loose, and Duan Jiali et al. and Peking University institute of child and adolescent health, respectively, form the largest cooperation community. Status, supervision, rural area, management, surveillance, health education, epidemiology, nutrition, environmental health, infectious diseases, common diseases, and influencing factors, etc. are hot topics in the field. Conclusion Cross-boundary exchanges and cooperation should be strengthened to promote regional coordinated development. Health risk behaviors of children and adolescents, environmental health surveillance and epidemiology of infectious diseases of primary and secondary schools, the school health personnel present situation investigation, children nutrition health and common diseases prevention and control, rural school health supervision and health education countermeasures, and school health management model were the hot topics, prevention of child injury, Internet addiction, and physical and mental health promotion were the leading directions. The commnunication and cooperation between different fields should be strengthened to improve the reginal development.

Purpose To discuss the clinical value of applying tissue motion tracking of mitral annular displacement (TMAD) technique to evaluate left ventricular global systolic function in patients with coronary heart disease. Materials and Methods Sixty patients with coronary heart disease who had at least one coronary stenosis ≥70% confirmed by coronary angiography were selected, and 35 healthy volunteer were enrolled as the control group. Three to five sequential two-dimensional dynamic images of cardiac cycle of four-chamber, three-chamber, and two-chamber apex cordis were collected and stored, and Qlab 7.0 software was used for off-line analysis. Maximal systolic displacement (Ds) of mitral annulus in six sites, systolic displacement of the middle point (D-mid) and left ventricular longitudinal fractional shortening (FSL) were measured and calculated for mean value respectively, which were then used for correlation analysis with left ventricular ejection fraction (LVEF) measured by simplified dual plane Simpson. Results ①Compared with control group, the mean value of Ds, D-mid and FSL of group A and B were significantly decreased, the difference of which was statistically significant (P<0.05). Compared with group A, the mitral annulus displacement parameters of group B decreased, the difference of which was statistically significant (P<0.05). ②Compared the time used for the two measuring methods: TMAD technology significantly reduced the measuring time compared to the two-dimensional dual plane Simpson's method (P<0.001). ③The mean values of Ds, D-mid and FSL in the control and coronary heart disease groups were all correlated with LVEF (r=0.77, 0.75, 0.78, P<0.001; r=0.78, 0.79, 0.78, P<0.001). ④Repeatability test: the intra-observer ICC values of the mean values of Ds, D-mid and FSL were 0.87, 0.85 and 0.93 respectively, and the inter-observer ICC values were 0.84, 0.84 and 0.88 respectively. Conclusion TMAD technology is time-saving, accurate and reproducible, which can be used to evaluate left ventricular systolic function in patients with coronary heart disease.

Objective To investigate the Suidasia nesbitti breeding status in the ground dust flour collected in Qiqihaer City. Methods Totally,16 aliquots of ground dust flour were respectively collected from a college canteen and 15 households in Qiq-ihaer City. Then 10 g dust flour was taken from individual sample for isolation of the mites that were made of slide specimen,and the mites were identified and classified under a microscope. Results Acaroid mites were found in 15 of the 16 aliquots of sam-ples(detection rate being 93.8%),and 7 species,belonging to 6 genera under 3 families,were identified. A total of 561 heads of mites were isolated from 160 g samples,with an average breeding density of 3.51 heads/g. The most breeding mite was associ-ated with S. nesbitti. Conclusions Various species of mites are breeding in the ground dust flour in Qiqihaer City,and S. nesbit-ti occurs the most. These findings indicate that effective measures should be taken to prevent and control the harm associated with acaroid mite contamination.

BACKGROUND:Recently, the effects of human umbilical cord mesenchymal stem cel s (hUCMSCs) and placenta-derived mesenchymal stem cel s (PDMSCs) on treatment of acute graft versus host disease (aGVHD) have been confirmed in some in vitro studies or animal models. But there are stil no reports comparing the therapeutic effects of these two cel types. OBJECTIVE:To compare the immunosuppressive function of hUCMSCs and PDMSCs in vitro or in a mouse aGVHD model. METHODS:(1) In vitro experiment. Human peripheral blood mononuclear cel s (PBMCs) were isolated and divided into four groups:PBMCs cultured alone, PBMCs stimulated with phytohaemagglutinin (PHA), PHA stimulated-PBMCs cocultured with hUCMSCs, PHA stimulated-PBMCs cocultured with PDMSCs. After 5 days, PBMCs proliferation and interferon-γlevel in cel supernatant were measured. (2) In vivo experiment. Fifty-seven BABL/C(H-2d) mice exposed to 8.5 Gy irradiation were randomly divided into five groups:only saline injection group, syngeneic bone marrow transplantation group, al ogeneic bone marrow transplantation group, aGVHD group, hUCMSCs treatment group, PDMSCs treatment group. The clinical aGVHD score, histopathology of skin, liver, and smal intestine, and survival time were analyzed at days 11, 14, 21 after transplantation. RESULTS AND CONCLUSION:(1) In vitro test:compared with the hUCMSCs, PDMSCs had stronger anti-inflammatory function. (2) In vivo test:The clinical scores on acute graft versus host disease were significantly lower in the hUCMSCs and PDMSCs treatment groups than that in the aGVHD group (P<0.05). The survival rates of mice were significantly increased in the hUCMSCs and PDMSCs treatment groups compared to the aGVHD group (P<0.05). Evident skin lesions were not found in al groups. Although smal intestine mucosal lesions were found in al groups, the damage level seemed similar. Notably, significant difference was found in the liver that multifocal necrosis and a large number of inflammatory cel s were seen in the aGVHD group, but less necrosis and inflammatory cel s in the hUCMSC and PDMSC treatment groups. In conclusion, hUCMSC and PDMSC are comparably effective in the treatment of aGVHD in mice.